Cannabis legalization in San Francisco: A health impact assessment

Nov 8, 2017
3 min read

Kudos to Cyndy Comerford and Max Gara from the San Francisco
Department of Public Health, Health Impact Assessment (HIA) Program!
Also, special acknowledgments to Michelle Kirian and Erik
Dove for their important contributions.

Excerpt from the Executive Summary

On November 8, 2016, California voters passed
Proposition 64, the “Adult Use of Marijuana Act.” This proposition
made it legal for individuals age 21 and older to use, possess, and
make non-medical cannabis available for retail sale.1 While the
legalization of cannabis may have direct benefits to communities, from
the regulation and taxation of cannabis sales to the substance’s
continued de-criminalization, the public health impacts of
legalization are lessor known. The legalization of adult use cannabis
is relatively new in the United States and therefore there is limited
and con icting evidence on its public health implications. This
report assesses the most up-to-date information and draws together
evidence from multiple sources to better understand the potential
health impacts associated with cannabis legalization in San
Francisco. The report aims to help inform discussions on the
legalization process and provide a health lens to more fully
understand its implications. This report uses a health impact
assessment (HIA) framework to evaluate any potential negative heath
impacts or harms to communities from legalization and strategies for
their preventions and/or mitigation. The following goals were used to
provide an overall structure to guide the project:

Prevent youth access and exposure to cannabis

Minimize potential harms to communities from cannabis use

Prevent the renormalization of tobacco product use and reverse of
declining use rates

Ensure perceptions of cannabis recognize risks associated with
use

Based on these goals, the following research question was formulated
for the analysis: What are the health impacts of adult use cannabis
retailers on San Francisco communities? More specifically, the report
wanted to evaluate: How does the density of and proximity to adult use
cannabis retailers impact youth exposure and neighborhood quality of
life?2 And how does allowing onsite consumption of adult use cannabis
impact youth exposure and neighborhood quality of life? For the latter
question, evidence in the literature was sparse and key informant
feedback was somewhat limited, thus it was not a focal point of the
report.

This assessment draws together evidence from multiple different data
sources to develop a holistic understanding of the health impacts
associated with cannabis legalization in order to answer the
aforementioned research questions. Data sources included
epidemiological data, scientific literature, expert and key informant
opinions collected from interviews and focus groups, and diverse
quantitative indicators associated with health and the neighborhood
environment. These data sources were analyzed for population wide
trends and strati ed to examine potential disproportionate impacts of
different sub-populations (e.g. by age, race/ethnicity) in following
with the goals of the report. Since adult use cannabis in the United
States is an emerging industry and there was limited evidence about
specialized cannabis services such as onsite consumption.

Recommendations

Take a measured approach to regulating adult-use cannabis.

Implement a robust public educational campaign.

Integrate cannabis into youth prevention programming.

Address potential disproportionate impacts to communities.

Strong regulation of cannabis edibles.

Develop advertising standards to protect youth and work to avoid
creating social norms.

Footnotes

The proposition allows the possession, transportation, purchasing and consuming up to one ounce of adult use cannabis and eight grams of adult use cannabis concentrates, and allows personal cultivation for up to six plants in a private residence.
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